Medicare Reference-Based Price Report

Many cost reduction strategies have been implemented and tested to address rising health care costs both locally and nationally. One model in particular – negotiating rates using Medicare payments as a reference – has proven effective in reducing health care spending. This analysis shows what commercial health insurance companies pay hospitals for inpatient and outpatient services as a percent of Medicare, along with patient experience and an overall quality rating. The data is also available by county and Division of Insurance (DOI) region across the state to help communities, employers, payers, providers, state agencies and others better understand local health care cost savings opportunities.

This report is based on a RAND Corporation analysis of commercial health insurance payments in the Colorado All Payer Claims Database (CO APCD) from 2015-2017.

Considerations

  • Data represents hospital-based claims for approximately 1.1M fully insured and small group covered lives, and 350K self-insured covered lives in Colorado
  • % Medicare payments reflect the percent above or below Medicare Fee-for-Service (100%) payments that were paid by commercial health insurance companies and patients
  • Percentage of Medicare represents the total commercial payment divided by the Medicare payment for those services where Medicare is the baseline at 100%

Medicare Reference-Based Price Report